The NHS Long Term Plan: first do no harm

By Savi Hensman

January 8, 2019

“As well as addressing today’s challenges, the NHS Long Term Plan sets the NHS up to seize the opportunities of the future”, claimed Matt Hancock, the health and social care secretary. But many others are sceptical.

This plan sets out what NHS England hopes to achieve in the next 10 years. Some aspects are good, others are more dubious or wishful thinking. Meanwhile harsh government policies continue to damage people’s health unnecessarily, undoing much hard work by staff, patients and carers.

As announced last June, funding is due to grow by an average of 3.4 per cent in real terms a year over the next five years, compared with two per cent in recent years, though still less than the average increase of 3.7 per cent since 1948. This would reduce the shortfall, though it is unclear that the money will be secured at a time of economic uncertainty.

Measures to improve services such as mental health and maternity, especially for the most disadvantaged, are welcome, as is reducing air pollution and antibiotic overuse. Better care for people with learning disabilities or autism, improved vaccination and screening programmes and earlier treatment for people with cancer, heart disease or stroke would benefit many. Removing at least some of the laws promoting privatisation would be a welcome move.

Yet pressing ahead with forms of ‘integrated’ care in which local people have little or no say would be unhelpful. So would over-reliance on new technology, long-distance consultations and genetics and on individual self-care; building trusting relationships with skilled professionals and strengthening public health can be vital. Experience has shown that ambitious plans which do not pay enough attention to the views and knowledge of those on the frontline – staff, patients, carers, communities – often fail.

Above all, it is time for the government to tackle the changes in law and public policy which undermine health, especially for those at risk because of poverty or being in a minority. A social security system which arbitrarily leaves adults and children destitute, low pay and insecurity for many workers, lack of decent affordable housing and struggling public services (including child protection) harm bodies and minds.

The ‘hostile environment’ for migrants, which has affected ethnic minorities more widely, and negativity to disabled people promoted by politicians and some media, have made matters worse. Heavy pressure on numerous public and private sector workers, in a constant attempt to squeeze more out of them, has deepened stress.

'First do no harm' is one of the principles of an oath taken by doctors in ancient Greece and is still an aspect of medical ethics. Perhaps this should be rolled out to those in charge of health services.

Justice and mercy are important for physical and mental, as well as spiritual, health. Though NHS leaders are understandably trying to do what they can with an overstretched – if slightly less inadequate – budget, major problems remain.

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